Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (i.v.) or intramuscularly (i.m.). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic i.v. drug users. There may also be a delay in patient response to opioid reversal with i.m. absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics. ⋯ Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of i.n. naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers.
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Comparative Study
Regional EMS experience with etomidate for facilitated intubation.
To report the preliminary experience of the Central New York emergency medical services (EMS) region with etomidate for prehospital facilitated intubation. ⋯ Preliminary data suggest increased rates of success for facilitated intubation using etomidate, when compared with diazepam, with most intubations successful on the first attempt. Limitations of this study include a small sample size and self-reporting of airway data by paramedics.
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To establish a register of randomized controlled trials of interventions in the prehospital care of trauma patients. ⋯ This register will facilitate the conduct of systematic reviews of the effectiveness of interventions in prehospital trauma care. However, despite the extensive searching, very few randomized trials in this area were found. In view of the absence of evidence for the effectiveness of many of the interventions that are used in the prehospital care of trauma patients, further randomized controlled trials are required.
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Previous studies of repeat care of the elderly have focused on trauma cases only. The purposes of this study were to identify repeat transports of elderly patients to the authors' emergency department (ED) by emergency medical services (EMS), to identify demographics, and to compare chief complaints. ⋯ Repeaters accounted for 18% of elderly ED patients transported by EMS and 40% of elderly transports to the authors' ED. There were significantly fewer trauma transports in the repeater group. One-half of the repeaters returned only once in a 12-month period and a third of these occurred more than three months apart. It is important to understand the characteristics of elderly EMS repeaters in order to use this opportunity for intervention.
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To examine the effect of a paramedic educational program and quality improvement feedback loop on paramedic-initiated nontransport of patients 65 years of age and older. ⋯ When paramedics were provided with objective feedback regarding outcome of patients not transported, the paramedic-initiated nontransportation and delayed hospitalization rates decreased, and the patient satisfaction level rose to 100%.